Registered Nurse with a successful and progressive record of experience in varied aspects of healthcare, including: Clinical Drug Trails, assisting with minor procedures, and a broad range of medical tests. Solid background in clinical trial coordination-experienced in preparing required reports and related administrative/control functions.
Excellent communication and interpersonal skills- proven ability to interact effectively with all levels of management, staff and patients. Well-organized and detailed oriented- capable of coordinating multifaceted assignments and responsibilities with maximum efficiency and accuracy.
Professional skills include: coding and compliance, medical necessity, billing reimbursement, CMS/AMA/OIG coding and billing regulations, revenue cycle management.
Knowledge of EPIC build as well as 20 different EMR’s, and multiple billing systems. Epic Ambulatory build and identity training.
Focused Compliance Officer bringing 15 years of expertise in regulatory compliance, audit procedures, project oversight and risk management. Excellent history of delivering effective leadership and training to support staff development. Driven and strategic with an aptitude for program management. Advanced knowledge of audit methodologies, functions and compliance teams.
Skills
Compliance Reviews
Project Coordination
Trend Monitoring
Controls Evaluations
Marketing Understanding
Risk Management Strategies
Reporting Requirements
Experience
04/2017 to Current
Director of Coding/Billing ComplianceATLANTIC HEALTH SYSTEMS, Epic – City, STATE,
Audit Coding/Billing Compliance and Revenue Cycle Functions, build for documentation templates, preference lists, charge router rules, scheduling, meaningful use, security access based on scope of practice and role
Assist revenue cycle in all aspect to ensure the front-end claims are correct to send them to claims processing
Responsible for claim testing build, charge router and interface issues
Epic build and Implementation for Ambulatory departments
Update all CPT and ICD10 changes every year
Business plan evaluation for all onboarding of practices, new services or service lines
Pre-audit and due diligence for all new providers and practices
Assist with claims scrubber automation and billing rules to streamline the revenue stream
Work all error queues for denials, appeals, and coding related issues from billing clearing house
Review all prepayment requests and appeals
Medical records department- Medicare risk assessment requests, legal request, insurance requests, and patient requests
Chart Amendment requests
Developed a release of information process for all physician practices
Developed archiving workflow for all medical records for all physician practice sites as well completed an assessment of all currently archived charts to ensure proper indexing for archiving for retrieval of charts and destruction based on state standards for medical record retention
Developed a decentralized scanning department along with a centralized indexing department for over 419 separate physician practice sites
Implemented a quality assessment workflow for scanning and indexing staff
Perform quarterly assessments of staff to ensure quality of work
Developed a chart correction for Epic for physician practice sites
Developed with the overall hospital system a Chart Correction Manual for all users
Oversee chart correction staff and ensure quality of corrected charts
Keep abreast of all CMS and AMA coding and documentation guidelines
Provide coding and documentation education for Physicians, Nurse Practitioners, Physician Assistants, Nurse Midwives, Fellows, CRNFA’s, CDE’s , LCSW, RD’s, and Residents
Responsible for reviewing approximately 1000 providers for billing, documentation and coding and provide feedback to the providers about the proper coding and billing guidelines
Manage, supervise, and trained a staff of 34 from managers, supervisors, auditors, indexers, chart correction specialists, medical record analysts, both remote and in office staff
Consultant for MSO Services for outside entities, over 100 practitioners, as their consultant MSO for all coding, documentation, and billing support
Supported strategic development and objective setting by analyzing audit outcomes and generating actionable recommendations.
Evaluated physical and digital records to determine potential risk and check compliance with guidelines.
Contributed to large-scale risk assessment initiatives and promoted improved business procedures and controls.
Completed quarterly and yearly audits.
Performed consistently with all quality objectives, including planning, control and optimization strategies.
Met with practitioners to implement best practice, project-manage needs and implement process improvements.
Perform bi-annual audits with education, as well as provide quarterly updates for all coding and billing guidelines to all provider and support staff
Primary Care Partners has 98 providers with 49 different site locations
Offered subject matter expertise to stakeholders needing advise on compliance regulations and coding/billing best practices.
Developed corporate risk management programs by establishing strict documentation and financial guidelines and spearheading risk management committee.
Built positive working relationships with other department managers through effective communication.
Executed successful compliance monitoring and risk assessment programs.
Created and managed training classes to educate new hires and existing employees about compliance concerns.
02/2008 to 04/2017
Manager of Coding/Billing ComplianceATLANTIC HEALTH SYSTEMS, Epic – City, STATE,
Epic build and Implementation for all aspects of coding, documentation, and billing for all practitioners
Testing for interface issues for correct providers, place of service
Training of providers on charge router billing
Ensure facility and professional side billing for services provided are coordinated and billed appropriately
Assist with overseeing clinic billing
Update all CPT and ICD10 changes every year
Find comparable code for all unlisted procedures
Business plan evaluation for all new services or service lines
Pre-audit and due diligence for all new providers and practices
Assist with claims scrubber automation and billing rules to streamline the revenue stream
Work all error queues for denials, appeals, and coding related issues from billing clearing house
Review all prepayment requests and appeals
Assisted with the ICD10 conversion for all Atlantic Health Systems and Atlantic Medical Group, crosswalks and training for all providers
RVU reconciliations for providers
Status questions Observation vs inpatient, outpatient hospital, on campus and off campus
Keep abreast of all CMS and AMA coding and documentation guidelines
Provide coding and documentation education for Physicians, Nurse Practitioners, Physician Assistants, and Residents
Familiar with “incident to”, shared services, inpatient and outpatient billing, and teaching guideline rules
Update state scope of practices for staff and providers
Responsible for reviewing approximately 980 providers for billing, documentation and coding and provide feedback to the providers about the proper coding and billing guidelines
Led, trained, and motivated 22 employees through supervision, training and coaching on duties and daily operational activities.
Implemented new hire training to further develop skills and initiate discussions on task prioritization.
09/2006 to 02/2008
Registered Nurse/Internal AuditorATLANTIC HEALTH SYSTEMS – City, STATE,
Performed internal audits on claims billed for billing and coding accuracy, for physician practices employed by the hospital for the corporate legal department
Drafted audit reports to display findings.
Created and implemented audit program that could identify risks and assess compliance requirements.
Provided detailed, yet understandable risk and compliance concepts to key stakeholders in organization.
Monitored new trends and technologies related to audit areas to implement modifications in processes and procedures.
Addressed and resolved audit issues.
Helped department leaders devise and implement remediation plans to address identified concerns.
Audited information and implemented data into spreadsheets
Reported on internal controls recommendations to Senior Leadership teams and Legal Counsel
Spearheaded planning of yearly audits and reviewed controls for departments to assess areas in need of improvement.
Assessed potential risks, evaluated controls and conducted compliance testing.
11/2004 to 09/2006
Registered Nurse/Site CoordinatorATLANTIC HEALTH SYSTEMS – City, STATE,
Facilitated opening of brand new OB/GYN Practice
Nursing/Coordinator functions included: ordering medical/office supplies, OR scheduling, triage of patient phone calls, precertification, assisting with minor procedures, reviewing and calling patients with test results, took patient histories, vital signs, ordered lab tests for physicians and counseled about available test results
Coordinated patient care activities for OB/GYN physician practice and handled assignments, order reviews, physician schedules and patient flow.
Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
Stocked clinical workstations and procedure rooms with necessary supplies.
Audited and completed charts, evaluations and medical forms.
Education and Training
Expected in 01/2007
CPC- Certified Professional Coder, certified: - , GPA:
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